Posts Tagged ‘Disruptive Technology’

Glass in Medicine – Why There is Promise

August 19, 2013

In an interview on GlassStories, Kyle Samani gives the most cogent discussion of the pros and cons of Glass. He emphasizes that there is a cost to glass – not just financial but the fact that you have to wear them all the time while you have a fully functional smart phone in your pocket. So he sees limitations to the appeal to general consumers other than the geek coolness. However, on the enterprise side, especially in medicine, he sees real use cases. Specifically,

  • physicians (and other healthcare providers) need their hands to work whether it is surgery or a physical exam
  • physicians (and other healthcare providers) are mobile whether moving from one exam or hospital room to the next or traveling between care sites
  • physicians (and other healthcare providers) are constantly interacting with people, either patients or colleagues
  • physicians (and other healthcare providers) need to look things up, communicate with others
  • physicians (and other healthcare providers) need to have clean hands – handling a mobile phone means transmitting germs, they need to wash their hands after each use even if they are using their mobile device at the bedside. The hands free commands in Glass enable them to avoid this
  • he also thinks the privacy concerns are exaggerated – less deceptive than a mobile phone

Watch the full video interview.

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Update on the Internet of Things and Google Glass

July 29, 2013

Since there already is a convergence of the Internet of Things (IoT) and wearable computing like Glass, I am combining updates on these.

Recently I came across Sen.se, a platform of IoT but includes data from humans as part of their open platform. They refuse the label of IoT:

“We rather believe in an Internet of Everything where Humans, Nature, Machines, Objects, Environments, Information, Physical and Virtual spaces all mix up, talk, intertwine, interact, enrich and empower each other in all sorts of ways. This is what we are building and we think that we are not alone.”

They are currently in beta and are inviting a limited number of users to the free platform. They also have a blog which is worth watching. Those in the Quantified Health community might check this out as an extension of human data with device and environmental data.

Second, I wanted to call attention to ReShape with Glass, an initiative by the ReShape Innovation Center at Radboud Hospital in Nijmegen, Netherlands. Already a healthcare innovation hub, ReShape will be on the cutting edge of healthcare uses for Glass. Follow them on Google+ .

Finally, I wanted to toot my own horn and mention my listing with some good friends as Best Healthcare IT Blogs . This is a nice addition to my status as one of the 10 healthcare IT professionals you should follow on Twitter.

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The Internet of Things Creeps into Healthcare

July 19, 2013

This post originally appeared on Health Works Collective.

One of the hottest trends in technology today is the Internet of Things or IoT. IoT was recently featured on the cover of Wired magazine for an article titled, “Awake: Welcome to the Programmable World.” The article begins, “When the objects around us can talk to each other, the elements of our physical universe converge and spring to life.” (Wired, June 2013 ).

The authors point out three stages for the IoT:

1) There need to be more devices on the network, everything from sensors to devices with embedded wireless.

2) The devices must coordinate with each other without human intervention.

3) Connected devices become ubiquitous, a programmable platform.

 

So is this just a techie dream born out of science fiction? And what is its relevance to healthcare?

There are several ways that hospitals are already part of the IoT. One big advance is smart IV pumps and their impact on patient safety. Not only can doses be preset, but the pumps can communicate with electronic medication administration records (eMAR) and bar code technology making them intelligent infusion devices.  The use of robotics in hospitals continues to grow. Robotic-assisted surgery isbecoming widespread if not controversial . Other uses of robots include, “packaging drugs or delivering lab results, and telemedicine-based technologies that connect clinicians and patients in ways that previously didn’t exist”.  Radio-Frequency Identification (RFID) is being used to track assets, such as, IV pumps, which can be difficult to find in a busy hospital or even hoarded. Others are using RFID to track medications administered to patients.

Another trend is the use of unique imaging technology, such as, Wireless Capsule Endoscopy, or camera in a pill, where the patient swallows this device and it moves through the GI track taking pictures as an alternative to the tube-based endoscope. (image at right from GIHealth)Image

It is only a matter of time, as these technologies mature and become ubiquitous, that these devices will begin to talk to each other and inform care throughout the hospital.

At the same time, the IoT is available to patients. The Quantified Self movement believes in monitoring many body functions from blood pressure to sleep and more. This is becoming fertile ground for innovation and startups are offering more consumer devices every week. One recent example is the Scanadu Scout that allows you to quickly check your vital signs by placing the device on your temple.  (image below from Scanadu) David Pogue of the New York Times wrote a review of many devices which promote health from companies like FitBit, Nike, Jawbone and Flex. But he also critiques them for lack of Bluetooth connectivity in some cases or less than adequate user interfaces.

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It is still early in the development of personal health devices for them to talk to each other or to larger systems through the Internet. In the area of telehealth, there are many devices and systems providing home monitoring of the chronically ill. These can provide an alternative to frequent clinic visits or visits by home health services when the data is reliably sent to the provider and algorithms are available to flag warning signs.  The Veterans Administration is moving forward with an extensive program of telehealth to serve veterans everywhere.

Finally, there is the rare startup that is focusing just on the IoT. One company out of Cleveland has even taken on that name, iOTOS. They have developed hardware, a wireless device, which can be imbedded in all kinds of devices which is tightly integrated with their proprietary software platform. iOTOS is just beginning to look at healthcare applications of the device/software from diagnostics to home monitoring. Because it is cloud-based, the devices can display data through mobile devices. (image below from iOTOS)

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In conclusion, the Internet of Things is creeping into healthcare, almost unnoticed. But the ubiquitous nature of IoT makes it self almost invisible to humans. Both in hospitals and at home, the possibilities are endless. Although we are early in the maturity of this technology as noted by the Wired article, we will soon connected devices become ubiquitous, a programmable platform, with medical devices talking to each other while improving care provision and our personal health.

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Further Thoughts on Google Glass

July 10, 2013

Here are some major advantages:

  • hands free browsing and video/photos
  • lightweight and minimally intrusive
  • can look at someone while browsing or during a hangout rather than looking down at a cell phone
  • many possibilities for uses in healthcare and medicine – see this article from iMedicalApps. One additional thought – how about physicians receiving alerts on their patients’ lab results via Glass
  • camera quality is excellent

Some downsides or challenges for developers to fix:

  • dependent on open wireless networks or activating your phone as a personal hotspot ($$$$$)
  • messages, searches and alerts limited to short text – considering the scale of the device, not sure how much more we can expect. If there is something that requires more detailed attention, we are at least alerted and can view it on a laptop
  • especially in healthcare, privacy concerns since one can take an image of anyone without their permission. Maybe the device should have a small light indicating that a recording or photo is being taken
  • If you are close to someone who also has Glass, their device might follow your verbal commands, “OK, Glass”. This actually occurred during my orientation
  • Availability of prescription Glass

Most of these are easy to solve. The challenge is using this new technology in healthcare, developing apps, use cases and broader adoption.

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Google Glass – Day 3 – Future Applications for Healthcare

July 9, 2013

On day 3, I brought Glass to work and introduced it to my staff and others at the hospital. Unfortunately, I could not connect to the internet thru Glass. The private wireless network did not allow a connection from the device and the public network requires browser authentication (like many airports and hotels) which is not possible in Glass. So the main demo was videos and photos I had already taken and demonstrating how to take photos and videos or having Glass read aloud alerts, such as, those from the New York Times.

So what applications are there for medicine and healthcare for this device? Already there are many ideas coming forward:

Other possibilites include real-time consults using Google Hangouts. This might be particularly effective in complex cases where the camera could be effectively used, such as, dermatology and wound care or my colleagues in ostomy care.
My final query is: who will develop the first healthcare app for Glass? Will it be an adaption of an existing wellness app involving diet and exercise or a medical reference app? By the way, medical reference at least on a basic level could already be experimented with using the Google search feature of Glass and realizing that the the answers will be brief.  Could medical calculators based on voice commands be apps? Would they be sufficiently accurate? Will apps be created which require FDA approval? How about patients wearing Glass to evaluate physician communication and the patient experience for training new medical professionals or seasoned ones?
Obviously, this technology is at an early but exciting stage. In healthcare, concerns about privacy abound, but as it becomes more common and the owner can explain how it is being used, there will develop a level of comfort, just as a skilled provider explaining the use of a computer in the exam room. The possibilities are only limited by the first 8000 Glass Explorers and those who will follow.

 

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Google Glass – Day 2

July 9, 2013

Day 2 was spent at home trying it out on my home network and showing it to neighbors. I was becoming more comfortable with using and wearing it. The hands-free aspect of Glass does have a freeing sense.

Sunday I discovered that a flood of NY Times alerts came through. Fortunately, Glass with read them to you if you like (headlines only). Also tried a Google search which resulted in a Wikipedia entry for some (first line) which was more or less relevant to my request. Since I don’t routinely use Siri or Google Voice, my proficiency with voice to text was lacking but this is something that could improve with practice.

Also attempted a video call to Lucien Engelen in the Netherlands. Unfortunately, it was choppy and the screen froze for both of us at times. Not sure if that was Glass, as I moved around the house trying to maintain the wireless connection or the speed of my wireless network or the international connection. Another item which  would require more trial and error, common with adopting new  technology.

Someone pointed me to this video by Sergey Brin at TED which starts with the intro to Glass and then his statements of the purpose of Glass – to move us away from staring down at our phones and again facing our fellow human beings while staying connected to the world. Interesting concept. Would like to see some human factor researchers do a test of highly connected people using a mobile phone vs. Glass.

Two examples of videos taken Saturday in NYC





These 20 second videos are easy to do with a voice command.
More tomorrow on potential applications in healthcare.

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Google Glass – Day 1

July 7, 2013

Guest tag for Glass

Today I went

to Google New York to pick up Google Glass. I arrived at Chelsea Market in southern Manhattan. On the 8th floor is the headquarters for Glass on the east coast. We were issued guest tags The setting is loft-like with a small bar (we were offer drinks) and sat at one of several tall tables on stools with a mirror.

After an extensive orientation, I was ready to try them on my own.

Right next to the Chelsea Market is the Highline. Tired out photos and video which both worked well.

Highline

As I was warned that unless you are connected through the MyGlass website to an available wireless network or an open network that does not require authentication. The other alternatives is to connect through your phone’s bluetooth or better yet, enable your phone as a wireless hotspot, but that is an additional cost.

 

 

 

 

 

 

 

Later in the day, I was in Grand Central Station and took photos and videos from the balcony, aka, Apple Store.

Grand Central

Conclusion from Day 1 – There is a learning curve for Glass. managing the menu and voice commands. Learning to share photos is pretty straightforward. Adding apps like The New York Times can add a lot of content. Finding Twitter and Facebook deep in the menu can be a challenge. And remember, sharing photos or messaging are through Google+. Also, the Glass app is for Android devices only right now. So between the learning curve and the dependence on Google Apps means a change in orientation compared to managing apps through an iPhone. But the process is still interesting.

Does Glass have uses within healthcare? a growing number of users think so but it is up to the first 8000 Glass Explorers to determine its usefulness and prove that it is more than a toy.

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Healthcare IT professionals you should follow on Twitter

June 4, 2013

There are actually many people to follow in this category but I was privileged to be first on this list by MedCityNews last week. Also, it put me in some good company, most of whom I already follow, such as, @jhalamka and the infamous @histalk.

This made me think of writing a brief post about how I use Twitter. I was an early adopter of Twitter starting just before attending Medicine 2.0 in Toronto in 2007. Meeting an energetic group from the US and Europe who were live tweeting at the conference got me hooked.

Now I have 5500 followers from Europe to Australia and follow about 1100.  I post 3-6 times per day and more often at conferences.  My focus in tweeting is health IT, health care social media, mHealth and apps, innovation in healthcare, conferences I attend, articles I read (newsletters and journals) and some notable Cleveland Clinic news.  I try to share quality information and almost always include links. I use my favorite hash tags #hcsm, #mhealth, #HIMSS, #EMR. Have not gotten into the habit of using #HealthIT or #HITsm yet.

I also promote some of my favorite people, such as, @berci, @healthythinker, @lucienengelen, @nicolaziady, @ReginaHolliday,@ahier and many others.

Overall, I try to provide quality information that I think is important and not get bogged down in criticizing others or off-color remarks.

I hope I can continue to earn the respect of the wild world of Twitterland. See you there.

 

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Many Predictions but Which Hit the Mark?

January 6, 2013

I was happy to have the opportunity to contribute to the iHealthbeat titled “11 Experts on Health IT Progress, Frustrations and Hopes for 2013″ with some very good company. I noted the growth of EMR adoption and mHealth. But I neglected an area which I will be more immersed in this year – Clinical Analytics which is one of the strongest growth areas in Health IT.

Another key set of predictions is by Lucien Engelen. Specifically, the trend toward changes in staffing in healthcare, specifically that more women are becoming physicians and more are looking at part-time work and flexible hours. Also, there are changes in location of care as length of hospital stays decrease and more care is done virtually through remote monitoring and remote communication.

Predictions about technology trends like mHealth need to be placed in the context of other changes in healthcare and there are many including the growth of the ePatient movement.

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Personal Year in Review

December 26, 2012

2012 may go down as a most traveled year for me both in terms of the number of trips and miles traveled but also in terms of new opportunities.

In January, I gave a lecture to the 3rd year medical students at the Cleveland Clinic Lerner College of Medicine on Biomedical Informatics challenging them to think about the future of algorithms in medicine among other topics.

Beginning in February, my chapter on eResearch in the book Health Informatics, was published.

Later in February, it was off to Las Vegas for HIMSS.  I was a guest of the Dutch delegation and spoke on Electronic Medical Records: From Clinical Decision Support to Precision Medicine. It was great to see Health IT social media colleagues at the HIMSS social media center. Also during February, I was invited to be on the advisory board for Health Works Collective and contributed to their interest in European trends with a blog post on How Europe is Growing Health Apps.

 

 

 

In March I attended the American Medical Informatics Association Clinical Research Informatics meeting in San Francisco. I presented two posters and one podium presentation all focused on the use of EMR data in research.

Then in April, it was on to the Netherlands for TEDx Maastricht and a visit to Radboud University Medical Center in Nijmeg en to meet at the ReShape & Innovation Center see a preview of the movie The Waiting Room. Also had a tour of the In Vitro programming there with ePatient Dave. Later in April I attend the Epic Research Advisory Council for the first time. Another valuable meeting of other user of the Epic EMR on the secondary use of EMR data in research and how to integrate research into the EMR.

Epic Campus near Madison, Wisconsin

Epic Campus near Madison, Wisconsin

May brought the publication of a blog post in iHealthbeat on A Look at Social Media in Health Care — Two Years Later , a follow up post on my original commentary on Healthcare social media from 2010. Also, I attended the Patient Experience Summit at the Cleveland Clinic which included fellow HealthWorksCollective bloggers Robin Carrey and Barbara Ficarra. Also published was a Technology Brief from the American Association of Medical Colleges on Mobile Apps. These one page summaries are targeted at medical school leadership.

June brought a trip to Barcelona for the Hospital Liquido conference. I presented an updated version of From Clinical Decision Support to Precision Medicine, This was a great opportunity to see one of Europe’s most beautiful cities as well as see the health IT innovation including Doctoralia.

Sagrada de Familia, Barcelona

Sagrada de Familia, Barcelona

In July I presented virtually at Salud 2.0 in Bilbao, another offering from Spain in medical innovation. My presentation on Social Media in Health Care: A Reasoned Approach was well received. I had the opportunity to answer questions via phone. Hopefully, I will be able to attend this conference in person in a future year.

In August, I was invited to become Adjunct Faculty at Kent State University in Health Informatics. Preparing a course in Clinical Analytics to be taught in May and June, 2013. This is a completely online masters program will be a new experience for me including online videos, readings, assignments and weekly discussion topics. At the end of August I attend the Ohio Health Data Symposium at Case Western Reserve University. Ohio like many states has a rich repository of public health information on everything from chronic diseases to behavioral health.

In early September, I completed a chapter on Computing and Information for a new textbook on Wireless Health: Remaking of Medicine by Pervasive Technologies. The concept of pervasive technology in healthcare is certainly at a tipping point. The book will be out in February 2013. Also in September I attended an internal Cleveland Clinic event, the annual Healthcare Technology Forum which showcased some of the many IT initiatives at all Cleveland Clinic locations including Abu Dhabi.

October 29-31, I attend the Cleveland Clinic Innovation Summit which focused on Orthopedics but included presentations by IBM, 23andMe and Explorys.

November took me to Chicago for the AMIA Annual Symposium. With record attendance (3500), I had the opportunity to organize and present a pre-symposium workshop on Clinical Research Informatics Infrastructure and a poster on the use of a wiki to educate healthcare professionals about secondary use of EMR data.  The same week I attend the Informatics Key Functional Committee of the Clinical and Translational Science Awards of the NIH. It was valuable to see what tools are being developed and particularly to attend the Integrated Data Repository workgroup. Also significant for AMIA this year was being featured on the website under Faces of AMIA and participating in the mentorship program, working with an up an coming informaticist, Anja Timmerman. I would encourage all experienced health IT professionals to participate in mentoring to bring along the next generation of informatics.

Chicago Millennium Park

Chicago Millennium Park

In December I presented at Cleveland Clinic Medical Informatics Grand Rounds on Use of an EMR-based Registry to Support Clinical Research. Mature EMR systems are quickly become key tools in all aspects of research

Quite a year of opportunities and evolution in my thinking. As you can see, much of my work is shifting from social media in healthcare (although this is still an interest of mine) to research informatics and specifically secondary use of EMR data. More later on what next year might bring.

 

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